C.M.R. 14, 193, ch. 6, EMERGENCY SERVICE STANDARDS - EMERGENCY SERVICE STANDARDS

These standards, in addition to the core standards, are applied to agencies providing emergency services.

Assessment

EM.1 There is documented evidence that the results of the assessment are discussed with the individual and/or the legally responsible party as appropriate.

Interpretive Guideline for EM.1

If the results are not discussed with the client or legally responsible party, the agency documents the reason(s) for not communicating this information.

Emergency Services

EM.2 A plan will be developed through an assessment of the client's immediate treatment, supervision, and support needs.

EM. 2. A. There is documented evidence that the agency assesses the individuals they serve.

Em. 2. B Every record of emergency contact or set of contacts around a particular incident will include documentation of the:

EM. 2. B.1 presenting problem;

EM. 2. B.2 history and precipitating factors;

EM. 2. B.3 assessing capacity to make reasoned decisions, danger to self or others, and ability to care for self; and

EM. 2. B.4 disposition, including referrals to other services as appropriate and indicated.

EM. 2. C. In instances in which the emergency services personnel are aware that the client receives community' support services and/or has an Individualized Support Plan, the agency shall, subject to the client's consent and the availability of the community support worker, coordinate the assessment and planning with the community support worker.

EM. 2. C.1 Services provided to these clients will be consistent with the targets and objectives of the Individualized Support Plan.

Interpretive Guideline for EM.2

A client's refusal or inability to consent is documented in the client record.

EM.3 Crisis and emergency workers shall collaborate with the client and the client's community support worker, if available, to determine the most appropriate, least restrictive environment for the client's stabilization and indicate this collaboration in progress notes.

Interpretive Guideline for EM.3

Crisis and emergency workers shall consider four options in priority order for least restrictive environment:

1. return to client's home or home of a family member or friend with or without additional out-patient on in-home treatment services;

2. stabilization in a short-term supported bed;

3. voluntary admission to a psychiatric facility; or

4. hospitalization in a secure facility.

EM.4 The agency has documented evidence that trained intervention personnel have consultation services of a psychologist or a psychiatrist available to them at all times.

EM.5 The agency maintains contact/progress notes on each client that include follow-up evaluations on the outcome of services and referrals.

EM.6 Crisis services shall be delivered in a timely fashion and be available 24 hours per day, seven days per week.

EM. 6. A. Trained crisis workers are available at all times through face-to face or phone contact.

EM. 6. B. The agency determines criteria 'for timeliness and monitors compliance with these criteria by documenting when a request for emergency service is made and when emergency services are delivered.

EM. 6. C. There are no substantiated complaints regarding access to emergency services. All substantiated complaints will be assessed for the seriousness of the violation and actions taken to achieve compliance.

EM.7 The agency has the capacity to provide face-to-face contact during normal business hours.

EM. 7. A. There are no substantiated complaints regarding refusal of face-to- face contact during normal business hours. All substantiated complaints will be assessed for the seriousness of the violation and actions taken to achieve compliance.

EM.8 All agencies have a capability, either directly or through arrangement, to assure face-to-face contacts off-site when necessary.

EM. 8. A. Agencies will have a written policy and procedure regarding steps to be taken when face-to-face contact with the client appears necessary. This document should minimally include procedures for contacting emergency service providers, e.g., police, EMT's, rescue, mobile crisis teams, or other professional emergency response organizations.

Em. 8. B. All crisis service agencies have access to personnel capable of processing involuntary hospitalizations, either directly or through written agreements.

EM.9 The agency has written criteria for follow-up contacts with clients who are at risk and documents these contacts in the client records.

EM. 9. A. Follow-up contacts are documented in the client's record and comply with confidentiality and informed consent standards.

Interpretive Guideline for EM.9

There are written criteria describing the process for follow-up contacts with clients at risk. This may include, but is not necessarily limited to the following: contacting other agencies, encouraging clients to call back and directly calling clients who consent to such follow-up.

EM.10. The agency develops intervention plans for clients with frequent or special needs.

EM. 10. A. The agency has written criteria and a process for developing intervention plans based upon frequency of contacts and acuity of needs.

EM. 10. A.1 Then is documented evidence that the intervention plan is developed with the participation of the client, legally responsible party and other representatives and professionals whom the client designates.

EM. 10. A.2. Clients shall under no circumstances be denied access to emergency services due to failure to comply with an intervention plan nor shall intervention plan be used to restrict access to emergency services.

EM. 10. B. There is documented evidence that intervention plans are periodically reviewed.

EM.11 There are written procedures to access rescue services, including a plan to update resource listings routinely.

EM. 11. A. There is documented evidence that rescue procedures are routinely followed and are systematically revised and updated.

EM. 11. B. There is evidence that staff members are trained in the agency's rescue procedures.

EM.12 The agency as documented evidence that services to victims/survivors of rape/incest are either provided directly or through referral.

EM. 12. A. If services are provided by the agency, there is documented evidence that staff members have received training relative to these services.

EM. 12. B. If services are not provided directly by the agency, the agency has a written policy and procedure regarding referral of these clients to a provider of these services.

EM.13 Crisis or emergency workers shall be licensed or certified to deliver mental health services in the State and have additional training in the delivery of emergency services.

Notes

C.M.R. 14, 193, ch. 6, EMERGENCY SERVICE STANDARDS